Provider Demographics
NPI:1891878567
Name:ONE STEP ORTHOTIC LABORATORY LLC
Entity Type:Organization
Organization Name:ONE STEP ORTHOTIC LABORATORY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAYIS
Authorized Official - Middle Name:
Authorized Official - Last Name:PATATANIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-858-5373
Mailing Address - Street 1:21785 FILIGREE CT
Mailing Address - Street 2:#211
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-6213
Mailing Address - Country:US
Mailing Address - Phone:703-858-5373
Mailing Address - Fax:703-858-5374
Practice Address - Street 1:21785 FILIGREE CT
Practice Address - Street 2:#211
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-6213
Practice Address - Country:US
Practice Address - Phone:703-858-5373
Practice Address - Fax:703-858-5374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAB602611332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA188613OtherANTHEM
VA010188024Medicaid
VA188613OtherANTHEM